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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197409614
Report Date: 01/16/2024
Date Signed: 01/16/2024 03:57:18 PM


Document Has Been Signed on 01/16/2024 03:57 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:CREATIVE YEARS NURSERY SCHOOLFACILITY NUMBER:
197409614
ADMINISTRATOR:DENISE BAYLISSFACILITY TYPE:
850
ADDRESS:21710 GOLDEN TRIANGLE ROADTELEPHONE:
(661) 254-0718
CITY:SAUGUSSTATE: CAZIP CODE:
91350
CAPACITY:187CENSUS: 58DATE:
01/16/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Cynthia Lewis, AdministratorTIME COMPLETED:
04:10 PM
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On Tuesday, January 16, 2024, Licensing Program Analyst (LPA) Mayra Rivera conducted an unannounced annual inspection and met with administrator Cynthia Lewis who guided LPA Rivera on a tour of the facility.

This is a preschool program that serves children ages 2 to 6 years. This program operates Monday to Friday 6:00 a.m. – 6:00 p.m. Sign in and out takes place at the main entrance area. LPA observed the children napping and teacher and child ratio were observed, and present staff are fingerprinted cleared and at least one person present who is trained in pediatric first aid/CPR is present.



For half day program LPA observed the classrooms (30 music and movement, 28 science/library, and 19 dramatic play) to have age-appropriate furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts and age-appropriate toys accessible to children. LPA observed cubbies stored in the hallway for children to store their personal belongings. LPA observed cleaning solutions stored on top of the cubbies and informed administrator Cynthia to store them in the cabinets. LPA Rivera observed a step trash bins with lids.

Full day program LPA observed classrooms (7 library, 12 art room, 14 dramatic play, 8 science, 3 music, and 1 art/dramatic play, 4 library) to have age-appropriate furniture and equipment to be in good condition, free of sharp, not loose, or pointed parts and age-appropriate toys accessible to children. LPA observed cubbies stored in the hallway for children to store their personal belongings. LPA observed cleaning solutions stored on top of the cubbies and informed administrator Cynthia to store them in the cabinets. LPA Rivera observed a step trash bins with lids.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CREATIVE YEARS NURSERY SCHOOL
FACILITY NUMBER: 197409614
VISIT DATE: 01/16/2024
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Heating, lighting, and ventilation were evaluated by LPA Rivera. LPA observed central AC/heater and vents located on the ceiling. LPA observed the thermostat to be at 71 degrees. LPA observed the required 2A10BC fire extinguishers located in classrooms and hallways and the valve on the green area indicating fully charged and serviced on 1/9/24.

LPA tested the dual smoke/carbon detector located in the hallway and heard the sound and is operable. The last emergency drill was conducted on 10/20/2023. LPA observed napping equipment cot’s to be in good condition. First aid kit supplies are kept inside the classrooms and LPA observed the kits to be fully equipped. During this visit, administrator Cynthia stated, currently has children with severe food allergies and with prescribed Epi Pens. LPA observed a total of 5 prescribed Epi Pen with expiration dates, 7/30/24, 7/20/24, 6/2024, 8/2024 and 11/2024. LPA Rivera asked if there were any poisons, firearms, weapons, or bodies of water. Administrator Cynthia stated no firearms, weapons, no poisons nor bodies of water. LPA did not observe firearms or weapons, poisons, nor bodies of water. Administrator stated the ill isolation area takes place in the director’s office and children will utilize staff restroom.

LPA Rivera observed the restrooms to be in good condition with working toilets, sinks, hand soap dispenser and paper towels. LPA observed a total of 9 toilets and 9 hand washing sinks.

At approximately 1:37 p.m. LPA Rivera entered the outdoor play area. LPA Rivera observed the equipment to be in a safe condition, free of sharp, no lose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. LPA Rivera observed play structure equipment to be age appropriate and areas around or under high climbing equipment, are cushioned with granulated rubber mat and sand that may absorb a fall. LPA did not observe hazard material in the sandboxes. For adequate shade, LPA Rivera observed hip roof shade structures. LPA observed the playground yard to be fenced and the side gate and slide gate closed and locked with a keypad lock. LPA observed trash bins with tight lids. For outdoor water drinking, staff bring out water jugs and disposable cups.


This program provides snacks and hot lunches. Parent’s also have the option to bring in the meals. LPA Rivera informed administrator any food brought from the children's homes, the container shall be labeled with the child's name and properly stored or refrigerated. For water drinking, LPA Rivera observed water pitchers and disposable cups in the classrooms. LPA observed the food preparation area to be clean and free

SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CREATIVE YEARS NURSERY SCHOOL
FACILITY NUMBER: 197409614
VISIT DATE: 01/16/2024
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of litter, rubbish, rodents, and/or any other vermin and storage containers for solid waste, including moveable bins with tight-fitting covers that are kept on, and in good repair. The facility was observed to be free of flies, other insects and rodents. Lead testing was conducted on 11/30/21 and no lead exceedance.

The following documents were posted in a prominent, publicly accessible area at the facility: Facility License, Notification of Parents' Rights (PUB 393), Personal Rights (LIC 613A), Menu, and Earthquake Preparedness (LIC 9148). PUB 269 Child Passenger System Poster, and Daily Schedule. LPA Rivera observed sign in/out sheets and observed 58 signatures.

LPA Rivera reviewed the children’s roster, children’s files and staff files and observed the files to be complete and certifications to date.


LPA Rivera observed director Denise Bayliss Pediatric First Aid/CPR certification from American Heart Association dated 6/1/23, and has proof of immunization against Pertussis, MMR and Influenza. Director has completed the mandated reporter (AB 1207) training dated 2/21/23. Director was advised that the mandated reporter training must be completed every 2 years, and is available at www.mandatedreporterca.com
Items discussed during this visit:
1. The following items are prohibited by Licensing: Refused Entry to a Facility or Any Part of a Facility is a violation of Section 1596.852, 1596.853 or 1597.09. Regulations 101238 (g) (2), The Presence of an Excluded Individual, Fire Clearance Violations, Accessible Bodies of Water, Accessible Firearms, Ammunition or Both

2. Breakfast/Lunch/Snack Menus: Menus are required to be posted one week in advance where it is visible by the child's authorized representative. Menus for the past 30 days must also be available upon request.

3. Current Children’s Roster: Each childcare facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.



4.LIC 311A - Records to be Maintained at the Facility: LPAs advised that forms, regulations and quarterly updates can be accessed on the Child Care Licensing website at: www.ccld.ca.gov.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CREATIVE YEARS NURSERY SCHOOL
FACILITY NUMBER: 197409614
VISIT DATE: 01/16/2024
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5.Pediatric First Aid and CPR: At least one person trained in Pediatric First Aid and CPR and EMSA approved must be present.

6.Designated Staff: The name of the childcare center director or fully qualified teacher(s) designated to act in the director's absence must be on file.

7.Qualifications: Educational background, training, and/or experience for each staff present must be available for review

8. Immunization Requirements: Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles or influenza declination

9.Children’s Records: must be available for review; including but not limited to, the following: Name, address and telephone number of the child's authorized representative and of relatives or others who can assume responsibility for the child if the authorized representative cannot be reached when necessary.

10.Staff Records: must be available for review; background clearance, LIC 503 Health Screening report, LIC 9108 Statement Acknowledging Requirement to Report Child Abuse, Staff Qualifications, LIC 9050 Employee Rights, LIC 501 Personnel Record, AB 1207 Mandated Child Abuse Certification, MMR, TDAP, TB, influenza or influenza declination.

Administrator Cynthia Lewis was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CREATIVE YEARS NURSERY SCHOOL
FACILITY NUMBER: 197409614
VISIT DATE: 01/16/2024
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Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test.

LPA verified that the lead testing was completed in accordance with the Written Directives outlined in PIN 21-21.1-CCP.

LPA Rivera discussed the safe sleep regulations with administrator Cynthia Lewis and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-andresources/safe-sleep as an additional resource. LPA also informed administrator Cynthia Lewis of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02CCP. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA are available at: https://www.ada.gov/resources/child-care-centers/.

Administrator Cynthia Lewis was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CC RO, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CREATIVE YEARS NURSERY SCHOOL
FACILITY NUMBER: 197409614
VISIT DATE: 01/16/2024
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A notice of site visit was given and must remain posted for 30 days. Failure to maintain posting as required will result in a $100.00 civil penalty.

Exit interview conducted and report was reviewed with administrator Cynthia Lewis.
SUPERVISOR'S NAME: Lady KingTELEPHONE: (661) 202-3318
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (661) 603-1090
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2024
LIC809 (FAS) - (06/04)
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